|
MAXZIDE(TRIAM/HCTZ) 37.5M 1TAB
|
Facility
|
OP
|
$4.47
|
|
|
Service Code
|
NDC 68001032700
|
| Hospital Charge Code |
25000952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Anthem Medicaid |
$1.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.49
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.71
|
| Rate for Payer: First Health Commercial |
$4.25
|
| Rate for Payer: Humana Commercial |
$3.80
|
| Rate for Payer: Humana KY Medicaid |
$1.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.93
|
| Rate for Payer: Ohio Health Group HMO |
$3.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.08
|
| Rate for Payer: PHCS Commercial |
$4.29
|
| Rate for Payer: United Healthcare All Payer |
$3.93
|
|
|
MB2 GUIDE CATH 5F
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem Medicaid |
$273.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Humana KY Medicaid |
$273.40
|
| Rate for Payer: Kentucky WC Medicaid |
$276.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
MB2 GUIDE CATH 5F
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
M-BLUE INJ FISTULA TRACT BREAS
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 19499
|
| Hospital Charge Code |
76102915
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Anthem Medicaid |
$325.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$325.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$331.50
|
| Rate for Payer: Molina Healthcare Passport |
$325.00
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$328.25
|
|
|
M-BLUE INJ FISTULA TRACT BREAS
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 19499
|
| Hospital Charge Code |
76102915
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: First Health Commercial |
$71.25
|
| Rate for Payer: Humana Commercial |
$63.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.00
|
| Rate for Payer: Ohio Health Group HMO |
$56.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.75
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
|
M-BLUE INJ FISTULA TRACT BREAS
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 19499
|
| Hospital Charge Code |
76102915
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.79 |
| Max. Negotiated Rate |
$4,953.45 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Anthem Medicaid |
$25.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: First Health Commercial |
$71.25
|
| Rate for Payer: Humana Commercial |
$63.75
|
| Rate for Payer: Humana KY Medicaid |
$25.79
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$26.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.00
|
| Rate for Payer: Ohio Health Group HMO |
$56.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.75
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
|
MBT POROUS TRAY SLEEVE 29MM
|
Facility
|
OP
|
$22,477.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,743.12 |
| Max. Negotiated Rate |
$21,577.98 |
| Rate for Payer: Aetna Commercial |
$17,307.34
|
| Rate for Payer: Anthem Medicaid |
$7,729.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,532.11
|
| Rate for Payer: Cash Price |
$11,238.53
|
| Rate for Payer: Cigna Commercial |
$18,655.96
|
| Rate for Payer: First Health Commercial |
$21,353.21
|
| Rate for Payer: Humana Commercial |
$19,105.50
|
| Rate for Payer: Humana KY Medicaid |
$7,729.86
|
| Rate for Payer: Kentucky WC Medicaid |
$7,808.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,431.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,588.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,743.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,884.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,779.81
|
| Rate for Payer: Ohio Health Group HMO |
$16,857.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,981.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,555.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,509.17
|
| Rate for Payer: PHCS Commercial |
$21,577.98
|
| Rate for Payer: United Healthcare All Payer |
$19,779.81
|
|
|
MBT POROUS TRAY SLEEVE 29MM
|
Facility
|
IP
|
$22,477.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,743.12 |
| Max. Negotiated Rate |
$21,577.98 |
| Rate for Payer: Aetna Commercial |
$17,307.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,532.11
|
| Rate for Payer: Cash Price |
$11,238.53
|
| Rate for Payer: Cigna Commercial |
$18,655.96
|
| Rate for Payer: First Health Commercial |
$21,353.21
|
| Rate for Payer: Humana Commercial |
$19,105.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,431.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,588.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,743.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,779.81
|
| Rate for Payer: Ohio Health Group HMO |
$16,857.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,981.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,555.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,509.17
|
| Rate for Payer: PHCS Commercial |
$21,577.98
|
| Rate for Payer: United Healthcare All Payer |
$19,779.81
|
|
|
MBT POROUS TRAY SLEEVE 37MM
|
Facility
|
OP
|
$25,561.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,668.38 |
| Max. Negotiated Rate |
$24,538.80 |
| Rate for Payer: Aetna Commercial |
$19,682.16
|
| Rate for Payer: Anthem Medicaid |
$8,790.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,937.78
|
| Rate for Payer: Cash Price |
$12,780.62
|
| Rate for Payer: Cigna Commercial |
$21,215.84
|
| Rate for Payer: First Health Commercial |
$24,283.19
|
| Rate for Payer: Humana Commercial |
$21,727.06
|
| Rate for Payer: Humana KY Medicaid |
$8,790.51
|
| Rate for Payer: Kentucky WC Medicaid |
$8,879.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,960.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,864.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,668.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,966.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,493.90
|
| Rate for Payer: Ohio Health Group HMO |
$19,170.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,449.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,238.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,637.26
|
| Rate for Payer: PHCS Commercial |
$24,538.80
|
| Rate for Payer: United Healthcare All Payer |
$22,493.90
|
|
|
MBT POROUS TRAY SLEEVE 37MM
|
Facility
|
IP
|
$25,561.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,668.38 |
| Max. Negotiated Rate |
$24,538.80 |
| Rate for Payer: Aetna Commercial |
$19,682.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,937.78
|
| Rate for Payer: Cash Price |
$12,780.62
|
| Rate for Payer: Cigna Commercial |
$21,215.84
|
| Rate for Payer: First Health Commercial |
$24,283.19
|
| Rate for Payer: Humana Commercial |
$21,727.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,960.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,864.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,668.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,493.90
|
| Rate for Payer: Ohio Health Group HMO |
$19,170.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,449.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,238.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,637.26
|
| Rate for Payer: PHCS Commercial |
$24,538.80
|
| Rate for Payer: United Healthcare All Payer |
$22,493.90
|
|
|
MBT POROUS TRAY SLEEVE 45MM
|
Facility
|
IP
|
$22,103.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,631.12 |
| Max. Negotiated Rate |
$21,219.60 |
| Rate for Payer: Aetna Commercial |
$17,019.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,240.92
|
| Rate for Payer: Cash Price |
$11,051.88
|
| Rate for Payer: Cigna Commercial |
$18,346.11
|
| Rate for Payer: First Health Commercial |
$20,998.56
|
| Rate for Payer: Humana Commercial |
$18,788.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,125.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,312.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,631.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,451.30
|
| Rate for Payer: Ohio Health Group HMO |
$16,577.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,683.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,230.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,251.59
|
| Rate for Payer: PHCS Commercial |
$21,219.60
|
| Rate for Payer: United Healthcare All Payer |
$19,451.30
|
|
|
MBT POROUS TRAY SLEEVE 45MM
|
Facility
|
OP
|
$22,103.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,631.12 |
| Max. Negotiated Rate |
$21,219.60 |
| Rate for Payer: Aetna Commercial |
$17,019.89
|
| Rate for Payer: Anthem Medicaid |
$7,601.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,240.92
|
| Rate for Payer: Cash Price |
$11,051.88
|
| Rate for Payer: Cigna Commercial |
$18,346.11
|
| Rate for Payer: First Health Commercial |
$20,998.56
|
| Rate for Payer: Humana Commercial |
$18,788.19
|
| Rate for Payer: Humana KY Medicaid |
$7,601.48
|
| Rate for Payer: Kentucky WC Medicaid |
$7,678.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,125.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,312.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,631.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,451.30
|
| Rate for Payer: Ohio Health Group HMO |
$16,577.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,683.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,230.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,251.59
|
| Rate for Payer: PHCS Commercial |
$21,219.60
|
| Rate for Payer: United Healthcare All Payer |
$19,451.30
|
|
|
MBT POROUS TRAY SLEEVE 53MM
|
Facility
|
OP
|
$20,513.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,154.12 |
| Max. Negotiated Rate |
$19,693.20 |
| Rate for Payer: Aetna Commercial |
$15,795.59
|
| Rate for Payer: Anthem Medicaid |
$7,054.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,000.73
|
| Rate for Payer: Cash Price |
$10,256.88
|
| Rate for Payer: Cigna Commercial |
$17,026.41
|
| Rate for Payer: First Health Commercial |
$19,488.06
|
| Rate for Payer: Humana Commercial |
$17,436.69
|
| Rate for Payer: Humana KY Medicaid |
$7,054.68
|
| Rate for Payer: Kentucky WC Medicaid |
$7,126.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,821.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,139.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,154.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,196.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,052.10
|
| Rate for Payer: Ohio Health Group HMO |
$15,385.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,411.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,846.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,154.49
|
| Rate for Payer: PHCS Commercial |
$19,693.20
|
| Rate for Payer: United Healthcare All Payer |
$18,052.10
|
|
|
MBT POROUS TRAY SLEEVE 53MM
|
Facility
|
IP
|
$20,513.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,154.12 |
| Max. Negotiated Rate |
$19,693.20 |
| Rate for Payer: Aetna Commercial |
$15,795.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,000.73
|
| Rate for Payer: Cash Price |
$10,256.88
|
| Rate for Payer: Cigna Commercial |
$17,026.41
|
| Rate for Payer: First Health Commercial |
$19,488.06
|
| Rate for Payer: Humana Commercial |
$17,436.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,821.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,139.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,154.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,052.10
|
| Rate for Payer: Ohio Health Group HMO |
$15,385.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,411.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,846.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,154.49
|
| Rate for Payer: PHCS Commercial |
$19,693.20
|
| Rate for Payer: United Healthcare All Payer |
$18,052.10
|
|
|
MBT REV METAPHEAL POR SLV 29MM
|
Facility
|
OP
|
$22,477.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,743.12 |
| Max. Negotiated Rate |
$21,577.98 |
| Rate for Payer: Aetna Commercial |
$17,307.34
|
| Rate for Payer: Anthem Medicaid |
$7,729.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,532.11
|
| Rate for Payer: Cash Price |
$11,238.53
|
| Rate for Payer: Cigna Commercial |
$18,655.96
|
| Rate for Payer: First Health Commercial |
$21,353.21
|
| Rate for Payer: Humana Commercial |
$19,105.50
|
| Rate for Payer: Humana KY Medicaid |
$7,729.86
|
| Rate for Payer: Kentucky WC Medicaid |
$7,808.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,431.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,588.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,743.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,884.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,779.81
|
| Rate for Payer: Ohio Health Group HMO |
$16,857.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,981.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,555.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,509.17
|
| Rate for Payer: PHCS Commercial |
$21,577.98
|
| Rate for Payer: United Healthcare All Payer |
$19,779.81
|
|
|
MBT REV METAPHEAL POR SLV 29MM
|
Facility
|
IP
|
$22,477.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,743.12 |
| Max. Negotiated Rate |
$21,577.98 |
| Rate for Payer: Aetna Commercial |
$17,307.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,532.11
|
| Rate for Payer: Cash Price |
$11,238.53
|
| Rate for Payer: Cigna Commercial |
$18,655.96
|
| Rate for Payer: First Health Commercial |
$21,353.21
|
| Rate for Payer: Humana Commercial |
$19,105.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,431.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,588.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,743.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,779.81
|
| Rate for Payer: Ohio Health Group HMO |
$16,857.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,981.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,555.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,509.17
|
| Rate for Payer: PHCS Commercial |
$21,577.98
|
| Rate for Payer: United Healthcare All Payer |
$19,779.81
|
|
|
MBT STEP WEDGE SZ 1.5 10MM
|
Facility
|
OP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem Medicaid |
$5,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Humana KY Medicaid |
$5,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,787.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,843.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 1.5 10MM
|
Facility
|
IP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 1.5 15MM
|
Facility
|
IP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 1.5 15MM
|
Facility
|
OP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem Medicaid |
$5,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Humana KY Medicaid |
$5,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,787.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,843.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 1.5 5MM
|
Facility
|
IP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 1.5 5MM
|
Facility
|
OP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem Medicaid |
$5,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Humana KY Medicaid |
$5,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,787.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,843.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 1 5MM
|
Facility
|
OP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem Medicaid |
$5,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Humana KY Medicaid |
$5,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,787.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,843.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 1 5MM
|
Facility
|
IP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 2 10MM
|
Facility
|
OP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem Medicaid |
$5,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Humana KY Medicaid |
$5,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,787.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,843.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
